Central Line-Associated Bloodstream Infections

Overview

Central line-associated bloodstream infections (CLABSIs) occur when germs enter the bloodstream through a central line. A central line is a tube that is placed in a large vein to give fluids, blood, or medications, or to do certain medical tests quickly.

Some patients may be at higher risk for developing a CLABSI due to length of hospitalization before catheterization, duration of catheterization, prematurity, underlying medical conditions, location of catheter placement, or other factors. (citation)  It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.

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In July 2008, Virginia hospitals with one or more adult intensive care units began reporting their CLABSI data to the Virginia Department of Health (VDH) through the National Healthcare Safety Network (NHSN) and have been reporting on a quarterly basis since then.  For more information on these data and the state regulation mandating their reporting, please see Public Reporting page.

In January 2011, the Centers for Medicare and Medicaid Services (CMS) began requiring acute care hospitals participating in their Inpatient Prospective Payment System (IPPS) to report CLABSIs in adult, pediatric, and neonatal intensive care units. These data will be made publicly available on Hospital Compare.

VDH HAI Program activities to address this issue:

• CLABSI data audit (October 2010 – February 2011):  Reviewed positive blood culture results from 37 hospitals to assess the validity of reported CLABSI data.  Interviewed infection prevention staff to identify educational gaps with data collection and surveillance definitions.
• CLABSI webinar to share lessons learned from audit (May 2011)
• CLABSI data audit final report

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Prevention Strategies for Healthcare Providers

To prevent CLABSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

• Follow recommended central line insertion practices to prevent infection when the central line is placed, including:
• Perform hand hygiene
• Apply appropriate skin antiseptic
• Ensure that the skin prep agent has completely dried before inserting the central line
• Use all five maximal sterile barrier precautions:
• Sterile gloves
• Sterile gown
• Cap
• Mask
• Large sterile drape
• Once the central line is in place:
• Follow recommended central line maintenance practices
• Wash hands with soap and water or an alcohol-based handrub before and after touching the line
• Remove a central line as soon as it is no longer needed. The sooner a catheter is removed, the less likely the chance of infection.

2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections

SHEA/IDSA Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals - CLABSI

CDC CLABSI toolkit for non-intensive care unit (ICU) settings – contains background on epidemiology of CLABSIs as well as core and supplemental prevention strategies

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Tools and Resources

APIC Guide to the Elimination of Catheter-Related Bloodstream Infections, 2009

CDC National Healthcare Safety Network (NHSN) Validation Guidance and Toolkit for 2012: Validation for Central Line-Associated Bloodstream Infection (CLABSI) in Intensive Care Units – resource to assist with internal or external validation of CLABSI data from ICUs. Includes recommended approaches to investigate and enhance the accuracy and completeness of 2012 CLABSI data in NHSN.

CDC Vital Signs Report: Making Health Care Safer – Reducing Bloodstream Infections (March 2011) – latest findings of progress on CLABSI prevention in different healthcare settings (hospitals and dialysis centers)

• Morbidity and Mortality Weekly Report (MMWR) – March 4, 2011 - more detailed information on methodology of Vital Signs report

Comprehensive Unit-Based Safety Program (CUSP) – safety project designed to improve safety culture and reduce CLABSI infections in participating hospitals.  In Virginia, this project is led by the state hospital association, Virginia Hospital & Health Association (VHHA).

NHSN Device-Associated Module – protocol and instructions, training, and forms

SHEA Patient Education Guide (BSI) – fact sheet that educates patients and their families about 7 types of HAIs (including CLABSIs) and how to work with healthcare professionals to prevent them.

VHQC – Healthcare-Associated Infections section contains central line daily assessment form and central line insertion practices monitoring tool

For more patient resources, please see the Consumer and Public Information page or go to the CDC CLABSI website.